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Clients often come to us with little more than hope to heal their mindless eating, binge eating, or overeating problems. During treatment, social workers generally focus on improving eating behaviors, stress management, and affect regulation. Although hope, emotional mastery, and "normal" eating skills are all important, therapists also need to help clients develop and practice traits—including curiosity, compassion for self, courage, patience, and persistence—that generate and sustain motivation throughout recovery.

Curiosity
Dysregulated eaters often mistake curiosity for self-judgment and berate themselves with comments such as, "What's wrong with me? Why do I continue to hurt myself with food?" They may be curious about their eating patterns, but are often uninterested in exploring avenues other than those of weight-loss dieting or exercise. Our job is to help them be curious, rather than judgmental, about how other aspects of their lives—such as upbringing, diet history, trauma, self-image, "self-sabotage," life stressors, and self-talk—undermine any positive relationship with food.

One component of curiosity is explained by Carol Dweck, PhD, in her book Mindset: The New Psychology of Success. Dweck identifies two types of mindsets: fixed and growth. People with a fixed mindset see themselves and their attributes or inadequacies as relatively permanent—they're good at some things and bad at others, outgoing or shy, lovable or unlovable. They have little curiosity about themselves or about how they might benefit from thinking or behaving differently in order to reach their goals. They view their successes as a "reflection of their more or less immutable gifts or talents" and their failures as a "reflection of unchangeable deficits and weaknesses." Many dysregulated eaters have fixed mindsets and lack sufficient curiosity about how to change themselves beyond improving their diet.

According to Dweck, "People with a growth mindset explain their successes entirely differently, as the result of conscious, actively chosen behaviors and strategies." They attribute their success to having practiced a lot, made healthy choices, or used rational thinking. She says, "When growth-mindset thinkers fail, they don't blame their intrinsic inadequacies, but look for different strategies to succeed as in 'Maybe I could try …'" In short, they are curious—not judgmental—about why they failed, and aren't already convinced that the reason for their lack of success is that there is something wrong with or defective about them.

Compassion for Self
Many, if not most, dysregulated eaters lack self-compassion. They're afraid that if they're not hard on themselves, they won't hold themselves accountable and that they'll accept their problem eating or body size as is; they won't be motivated to change. They view negative self-talk as necessary to success (in spite of their repeated failures with it to keep weight off). We must teach them that this is exactly the wrong approach to take for eating disorder recovery.

Kristin Neff, PhD, writes eloquently and persuasively about self-compassion in her book Self-Compassion: The Proven Power of Being Kind to Yourself. Neff describes compassion as meeting suffering with kindness and makes a convincing case for its foundational need in maintaining motivation and achieving success. In brief, she explains that when we say harsh, judgmental, hurtful things to ourselves, we feel badly, making us less prone to want to move forward to reach our goals and more likely to give up. Alternately, when we say kind, caring, loving, positive things, we feel better and are more likely to feel motivated to keep on keeping on.

Sadly, we live in a culture that discourages self-compassion. In fact, it fosters the opposite mentality through messages such as, "no pain no gain," "tough it out," "don't be a wuss," "that which doesn't kill us makes us stronger," "quit being a baby," "be strong," and "big girls and boys don't cry." Moreover, many dysregulated eaters were raised by parents who possessed minimal self-compassion and had scant compassion for their children, so "be tough on yourself" is the only approach to self-improvement that these clients know.

Dysregulated eaters have plenty of opportunity to practice self-compassion, such as when they binge eat, overeat, or eat mindlessly; let their gym membership lapse; or forgo a run to watch mind-numbing TV. Even when they're hard on themselves, they can practice self-compassion by gently reminding themselves that are just learning this essential skill. Self-compassion is a game-changer and clients will not fully recover without it.

Courage
Too often clients think of courage as strength to hold on to what is, not as strength to change what needs changing. In our culture, courage is often portrayed by one simplistic act of might, right, or power. The courage that clients need in order to heal is of a different sort: to try and sometimes be wrong; to do something they've never done because they, or we, think that it might help them; or to give up what's known (e.g., comfort eating, diets, weighing themselves, and negative self-talk) and enter a world of uncertainty because what's known only brings them pain. This is a very tall order, as clients frequently point out when they complain, "but it's hard."

Clients often think of courage as being "strong"; beating back memories of failure, trauma, or dysfunctional childhoods; clinging to denial and intellectualization; and pretending that they're fine in spite of grave suffering. This perspective is the antithesis of courage and is, rather, one that is frozen by fear. For courage means facing life not as we wish it to be, but as it has been and still is.

Feel the Fear … and Do It Anyway by Susan Jeffers, PhD, is an enlightening read for clients, providing the real scoop on fear and courage: we cannot wait for fear to disappear to do something, but must acknowledge it, and that the only way out of this state is to do the thing that we fear. Moreover, because dysregulated eaters often lack patience, it's crucial for us to help them pace confronting their fears, lest they take on too much, fail, and vow never to try again.

Patience
Of all the emotional traits that are lacking in dysregulated eaters, patience, reinforced by the quick-fix mentality of diets and our culture, may top the list. Patience is built on tolerating frustration, delaying gratification, and managing impulsivity. Frustration tolerance means helping clients endure not being where they want to be in order to get there eventually. They can be taught to tolerate the inner tension they feel by increasing positive self-talk, focusing on their goals and especially their values, and taking incremental action via baby steps.

The ability to delay gratification involves clients saying no to what they want now because of how they'll benefit later. It develops from their staying focused on consequences rather than on current cravings and from being able to wait for rewards. Obviously, it's helped along by their ability to tolerate frustration and keep their eyes on the prize.

Impulse control involves self-governance—not giving in to and acting on every urge that clients experience, but, rather, taking only deliberate, conscious actions. Many clients believe that they must act on every thought that pops into their heads.

Therefore, we must teach them how to distance or distract themselves from unhealthy urges through mindfulness, cognitive behavioral therapy, or thought stopping. Of course, managing impulses effectively relies heavily on both frustration tolerance and delayed gratification.

Persistence
Persistence is the deal-breaker when it comes to clients resolving their eating problems. It means keeping at it no matter what. It rests on clients holding on to hope, being resilient in the face of failure, having faith in themselves and in our guidance, confronting challenges, learning new skills, and believing that the only way they'll fail is if they stop trying. Equally, it rests on us never giving up on helping them to take better care of themselves.

Persistence, also known as grit, figures prominently in a book by Angela Duckworth, PhD, Grit: The Power of Passion and Perseverance. According to Duckworth, grit equals passion plus long-term commitment to a higher goal reinforced by ongoing commitment to smaller goals. If the higher goal is "normal" eating, smaller goals for clients might be eating only when they're hungry, choosing satisfying foods rather than calorie counting, eating mindfully without distractions and with an eye toward enjoyment, and putting down their knives and forks when they're full or satisfied.

Grit is rooted in clients desiring to be comfortable around food more than they want anything else in the world, rejecting easy answers and quick fixes, and holding a realistic vision of success that drives them forward in spite of mistakes and relapses. As Duckworth says, "Enthusiasm is common. Endurance is rare."

Persistence is the final touch in the process of clients going from mindless eating, binge eating, and overeating to enjoying an appetite-cued, comfortable relationship with food.

If clients are to succeed in this endeavor, and if we are to guide and support their success, we must help them acquire and practice curiosity, self-compassion, courage, patience, and persistence as the basis for change, healing and, ultimately, a full recovery.

— Karen R. Koenig, MEd, LCSW, is an expert on the psychology of eating, and an international author of seven books on eating and weight including Helping Patients Outsmart Overeating: Psychological Strategies for Doctors and Health Care Providers.